IMPACT OF CAROTID ENDARTERECTOMY ON COGNITIVE PERFORMANCE AND DEPRESSIVE SYMPTOMS

Elina Pucite,Ildze Krievina,Marius Slisers,Kristaps Jurjans,Evija Miglane,Renars Erts,Dainis Krievins

doi:10.12955/cbup.v4.820

Abstract

OBJECTIVES: This study aims to evaluate the impact of carotid endarterectomy (CEA) on cognitive performance in patients with severe carotid disease and depressive symptoms, and to explore the possible associations between certain demographics, clinical characteristics, and cognitive function and depression.MATERIALS AND METHODS: The study included 48 patients, who were referred for endarterectomy. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) scale, while depressive symptoms were assessed using the patient health questionnaire(PHQ-9) scale. An assessment of cognitive and depressive symptoms was performed 1–3 days before surgery, and then six months after.RESULTS: A paired sample t-test found that the difference in the mean MoCA score between the before (=23.37; SD ± 3.27) and the after (=24.69; SD ± 3.68) surgery results was 1.32 (95% CI = 0.48 – 2.16; p= 0.003; Cohen’s d value = 0.95). A paired sample t-test showed that a decrease in mean PHQ-9 score of > 10 for patients six months after CEA (7.5±4.6) was statistically significant (p= 0.019; Cohen’s d value = 1.32) compared with the PHQ-9 scores at baseline (12.6 ± 2.8).CONCLUSION: Carotid artery endarterectomy seems to have beneficial effects on the course of cognitive impairment and depressive symptoms in patients with severe carotid artery stenosis. Demographic, clinical characteristics (age, gender, comorbidities, previous stroke) did not have impact on course of cognitive and depressive symptoms. A limitation in our study was that the number of patients was relatively small, therefore we intend to perform further study with larger case volume to estimate the impact of carotid artery endarterectomy on cognitive functions and depressive symptoms.

Highlights

Vascular cognitive impairment was understood entirely as a condition resulting from a symptomatic ischemic or hemorrhagic event, i.e. stroke
A paired sample t-test found that the difference in the mean Montreal Cognitive Assessment (MoCA) score between the before ( =23.37; SD ± 3.27) and the after ( =24.69; SD ± 3.68) surgery results was 1.32
A paired sample t-test showed that a decrease in mean PHQ-9 score of > 10 for patients six months after carotid endarterectomy (CEA) (7.5±4.6) was statistically significant (p= 0.019; Cohen’s d value = 1.32) compared with the PHQ-9 scores at baseline (12.6 ± 2.8)

Summary

Introduction

Vascular cognitive impairment was understood entirely as a condition resulting from a symptomatic ischemic or hemorrhagic event, i.e. stroke. In 2006, the National Institute of Neurological Disorders and the Stroke-Canadian Stroke Network recommended the Montreal Cognitive Assessment (MoCA) test, or some of its subtests, as an optimal brief protocol for the assessment of vascular cognitive impairment (Hachinski et al, 2006, Popovic, Lovrencic-Huzjan, & Demarin, 2009; Popovic et al, 2011). The MoCA compares or favorably to the mini-mental state examination (MMSE) in terms of sensitivity to cognitive impairment and sensitivity to change, over time (Koski, 2013). Depression is one of the most prevalent and treatable mental disorders presenting in general medical as well as specialty settings (Kroenke & Spitzer, 2002). Few epidemiologic studies have examined the association between depressive symptoms and atherosclerosis in subjects aged ≥65 years

Objectives

Methods

Results

Discussion

Conclusion